Quiet Crisis in BC's Healthcare System
By Bren Simmers, The Martlet - UVic

Alison Fox quit nursing in Vancouver in 1992, three years before Chretien's Liberal government made the deepest cuts to provincial transfer payments since the birth of national medicare in 1966. Even then, she was disillusioned with the medical establishment because of the socio-economic factors that make people sick in the first place, and was unable to provide the kind of care she wanted to give.

Although trained in holistic medicine, Fox found herself spending much of her time handing out drugs, a common response to illness in a medical system rooted in symptom management. As Fox points out, we need to start asking ourselves where sickness fits in with family history, stress patterns, and lifestyle.

Fox chose nursing because she enjoys taking care of people, tending to both their physical and emotional needs. But in two years, she recalls only three instances when she was able to spend time using massage or other alternative therapies to relieve a person's pain.

In today's hospitals, there is little time for that kind of care, but Fox says she has seen its benefits first hand.

Alternative medicine is inching its way into Canada's traditional health care system. You used to have to get a doctor's order for physiotherapy - now massage is partially covered under B.C. medical.

"An informed and active consumer movement can change things and has," says Fox. Patients are asking more questions and are becoming more aware of their options. Still, if a person wants to access alternative therapies in Canada right now - acupuncture, homeopathy, hypnosis or naturopathy - they do so at their own expense.

"After 15 years of training, I am unable to do my job," he says. Lack of funding to hire support staff such as nurses and cleaners, have reduced his hospital operating hours to as low as six hours a week.

"Everyone is doing a different job than they were trained for," he says. Hospital staff are overworked and morale is low. "This should be an exciting time to be a doctor, with new developments in technology, but we're unable to do our jobs." With a young family and a career ahead of him, Freedman says he can't afford to stay in Victoria. Doctors used to belong to the upper-middle class, a compensation well deserved for their years of training, says Freedman, but now they are feeling the economic pinch. In the States, "people need you and they reimburse you. Money is part of it, but it's the level of satisfaction you get for doing the job you're trained to do with the right equipment."

Health care critic Michael M. Rachlis argues that the problem isn't so much a shortage of doctors as it is how they are paid for their time. He believes doctors and specialists are moving away from comprehensive care, such as prevention and phone calls, because they're not paid for it under the current system. When a doctor has 10 minutes to see a patient, it is impossible to provide this kind of care.

For students without primary physicians, drop-in clinic visits do little to address health concerns. Stress, poor eating habits, lack of exercise and poverty are at the root of most student illnesses. Unfortunately, in the current health care system, not even your regular doctor has time to talk to you and help you figure it out.

"We won't have many family physicians in the future," says the University of Victoria's health services physician Dr. Robert McDonald, a general practitioner who has worked in Canada for the past 11 years. "They're often dealing with complex, multiple pathologies, yet they get paid the same as a person treating colds and flus.

So how can we keep good doctors and nurses in Canada and ensure they have the ability to provide adequate care? "There's just not enough money in the system," says McDonald, "and it leads to burn-out." B.C.'s budget offers $1.6 billion for doctors' services.

Rachlis argues that switching over to salary-based integrated health centres would solve problems in rural areas. The vision is that generalists and specialists form a team, and get paid a salary with benefits to attract doctors to rural areas with fewer physicians and even fewer specialists. But not all critics agree.

Freedman believes that money motivates most doctors. Switching to salaried pay would control the budget, but would result in a collapse of the current system. Doctors would work regular office hours and have leisurely lunch and coffee breaks, instead of their usual 60-hour workweek. More doctors would be required under a salary system, due to a shorter workweek. And doctors, says Freedman, is what we're already short of.

Money can't possibly be the prime motivator keeping nurses working in Canada. According to the B.C. Nurses Union, the starting wage for a nurse in December 1990 was $18.23 an hour. As of September 2000,it was $21.40 equating - a wage increase of only $3.17 in 10 years. The starting wage paid to nurses' aides, however, has jumped from $13.10 to $20.25 in the same time frame.

In the current setup, doctors and nurses have two distinct roles, with doctors at the top of the hierarchy in terms of responsibility. Nurses are paid to care for the patients for whom doctors provide diagnosis and treatment. You can't advocate for nurses to be more like doctors in both practice and pay without providing the proper training, says McDonald. "Most physicians would have a problem with nurses having the final responsibility without being bound ethically, medically and legally to accept that responsibility on their own."

Imagine an active man in his 20s. It's his last year of university. While playing hockey, he falls on his tailbone and ruptures his bottom disc. His doctor prescribes painkillers. He goes to physiotherapy. Nothing helps. It is painful to sit through a 50-minute lecture. Six months later, his doctor refers him to a specialist. He is put on a waiting list for surgery. But waiting lists are usually so large that they don't mean much. Some people on the waiting list have already had their surgery. Others are on three waiting lists at the same time.

In 1998, Health Canada produced a report criticising waiting lists as capriciously organised and poorly monitored. It concluded that waiting lists are instruments of misinformation, propaganda and general mischief at worst, as they aren't standardised or monitored. Morris Barer, director of the UBC Centre of Health Services and Policy Research, is one of the authors of the study that says waiting lists are "owned and managed by individual physicians."

He believes there is room for a parallel system or privatisation of certain services. He says that some can and will pay for quality health care. Health care, says Freedman, was originally started to cover the costs of major illnesses or accidents, so that people wouldn't go bankrupt. It wasn't designed for colds, or check-ins. "If people want that kind of care, they are going to have to pay more for it like in the US." At the same time, he argues that "the welfare state is here to stay. Some people will always need free health care, but will free health care be as good as private health care? The answer is no."

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